{ "url": "https://allermi-site.vercel.app/reviews/allermi/", "collection": "reviews", "slug": "allermi", "frontmatter": { "title": "Allermi (compounded nasal spray): 2026 Review", "description": "Allermi review (test trigger 1777405102)", "lastReviewed": "2026-04-28T00:00:00.000Z", "firstPublished": "2025-10-15T00:00:00.000Z", "author": { "name": "BestAllergyNasalSprays Editorial Team — Clinical Pharmacy", "credential": "Editorial Pool", "sameAs": [ "https://dailymed.nlm.nih.gov/", "https://www.fda.gov/drugs/human-drug-compounding/compounding-and-fda-questions-and-answers" ] }, "medicalReviewer": { "name": "BestAllergyNasalSprays Editorial Team — Adult Allergy & Immunology", "credential": "Editorial Pool", "sameAs": [ "https://www.aaaai.org/", "https://www.acaai.org/" ] }, "primaryKeyword": "allermi review", "ymylTier": "high", "citations": [ { "id": "1", "title": "FDA: Compounding under Section 503A", "url": "https://www.fda.gov/drugs/human-drug-compounding/compounding-and-fda-questions-and-answers", "publisher": "FDA", "tier": "regulatory" }, { "id": "2", "title": "Dykewicz 2020: Rhinitis practice parameter update", "url": "https://pubmed.ncbi.nlm.nih.gov/32707227/", "publisher": "JACI", "year": 2020, "tier": "tier-1" }, { "id": "3", "title": "Seidman 2015: Combined medical therapy for rhinitis systematic review", "url": "https://pubmed.ncbi.nlm.nih.gov/29034124/", "publisher": "PubMed", "year": 2017, "tier": "tier-1" }, { "id": "4", "title": "Bernstein 2007: Azelastine pharmacology review", "url": "https://pubmed.ncbi.nlm.nih.gov/17433827/", "publisher": "PubMed", "year": 2007, "tier": "tier-2" }, { "id": "5", "title": "Bronsky 1995: Ipratropium nasal for rhinorrhea", "url": "https://pubmed.ncbi.nlm.nih.gov/7499678/", "publisher": "PubMed", "year": 1995, "tier": "tier-2" }, { "id": "6", "title": "Vaidyanathan 2010: Fluticasone reverses oxymetazoline rebound", "url": "https://pubmed.ncbi.nlm.nih.gov/20203244/", "publisher": "PubMed", "year": 2010, "tier": "tier-2" }, { "id": "7", "title": "Kumar 2022: Fluticasone furoate + oxymetazoline RCT", "url": "https://pubmed.ncbi.nlm.nih.gov/35712651/", "publisher": "PubMed", "year": 2022, "tier": "tier-2" }, { "id": "8", "title": "Mygind 2008: Intranasal corticosteroid pharmacology", "url": "https://pubmed.ncbi.nlm.nih.gov/18384455/", "publisher": "PubMed", "year": 2008, "tier": "tier-2" }, { "id": "9", "title": "DailyMed: Azelastine nasal SPL", "url": "https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=70b079e2-a1f7-4a93-8685-d60a4d7c2c5a", "publisher": "FDA DailyMed", "tier": "regulatory" } ], "tldr": "Allermi is a telehealth compounded nasal spray that combines up to four FDA-approved actives (azelastine, triamcinolone, ipratropium, and micro-dosed oxymetazoline) in a single bottle personalized by a board-certified allergist. Each active ingredient is FDA-approved and used on-label for rhinitis; the finished compounded formula is not separately FDA-approved as a fixed-dose combination. Approximately $45/month subscription (promotional first-month pricing from $95). Available to patients ages 13+ across most US states (not available in AR, DE, KS, MS, WV, ND, RI, or DC). Not currently prescribed to patients who are pregnant or breastfeeding.", "claims": [ "c-001", "c-002", "c-003", "c-004", "c-005", "c-006", "c-007", "c-009", "c-010", "c-011", "c-012", "c-013", "c-014", "c-015", "c-021", "c-036", "c-041", "c-049", "c-050", "c-062", "c-064", "c-067", "c-068", "c-075", "c-079", "c-080" ], "draft": false, "speakableSelectors": [ ".answer-box", ".claim", "h1", "h2" ], "takeaways": [ { "text": "Compounded 4-ingredient nasal spray, allergist-personalized via telehealth", "tier": "expert" }, { "text": "Each active FDA-approved on-label for rhinitis; compounded formula not separately FDA-approved", "tier": "fda-label" }, { "text": "Combination therapy rationale supported by RCT + meta-analysis evidence", "tier": "meta-analysis", "detail": "Seidman 2015; Carr 2012" }, { "text": "Micro-dosed oxymetazoline paired with steroid: studies suggest substantially reduced rebound risk", "tier": "rct", "detail": "Vaidyanathan 2010; Kumar 2022" }, { "text": "Available to patients ages 13+ in 39 states (18+ in AK/NM/OR/SC; not in AR/DE/KS/MS/WV/ND/RI/DC); not prescribed in pregnancy or breastfeeding", "tier": "expert" } ], "publishHistory": [ { "date": "2025-10-15T00:00:00.000Z", "what": "Initial publication." }, { "date": "2026-04-21T00:00:00.000Z", "what": "Quarterly review: pricing verified, FDA compounding Q&A link checked." }, { "date": "2026-04-28T00:00:00.000Z", "what": "Eligibility update: now 13+ in 39 US states (18+ in AK/NM/OR/SC). Pricing updated to $45/mo subscription. Editorial oversight clarified to the BestAllergyNasalSprays team. Reviewer bylines moved to editorial-team framing." } ], "subtitle": "Telehealth compounded multi-ingredient nasal spray (azelastine, triamcinolone, ipratropium, micro-dosed oxymetazoline).", "related": [ { "href": "/allermi/allermi-vs-flonase/", "label": "Allermi vs Flonase", "kind": "Head-to-head", "description": "Compounded 4-active Rx vs first-line OTC steroid." }, { "href": "/allermi/allermi-vs-astepro/", "label": "Allermi vs Astepro", "kind": "Head-to-head", "description": "Compounded combo vs standalone OTC antihistamine." }, { "href": "/allermi/allermi-vs-dymista/", "label": "Allermi vs Dymista", "kind": "Head-to-head", "description": "Compounded 4-active vs FDA-approved 2-active Rx combo." }, { "href": "/allermi/allermi-vs-nasacort/", "label": "Allermi vs Nasacort", "kind": "Head-to-head", "description": "Multi-ingredient Rx vs OTC triamcinolone alone." }, { "href": "/allermi/allermi-vs-nasonex/", "label": "Allermi vs Nasonex", "kind": "Head-to-head", "description": "Compounded vs low-systemic OTC mometasone." }, { "href": "/allermi/allermi-vs-sensimist/", "label": "Allermi vs Sensimist", "kind": "Head-to-head", "description": "Compounded vs gentle OTC fluticasone furoate." }, { "href": "/symptom/congestion/", "label": "Best nasal spray for congestion", "kind": "Symptom", "description": "Where Allermi sits for moderate-severe congestion." }, { "href": "/symptom/runny-nose/", "label": "Best nasal spray for runny nose", "kind": "Symptom", "description": "Ipratropium component targets rhinorrhea directly." }, { "href": "/symptom/post-nasal-drip/", "label": "Best nasal spray for post-nasal drip", "kind": "Symptom", "description": "Drip-plus-inflammation is Allermi's sweet spot." }, { "href": "/symptom/itchy-nose/", "label": "Best nasal spray for itchy nose", "kind": "Symptom", "description": "Azelastine component for fast histamine relief." }, { "href": "/about/ownership/", "label": "Ownership & editorial independence", "kind": "About", "description": "How this site's Allermi ownership is disclosed." }, { "href": "/methodology/", "label": "How we rank nasal sprays", "kind": "Methodology" }, { "href": "/demographic/pregnancy/", "label": "Safe nasal sprays in pregnancy", "kind": "Demographic", "description": "Why Allermi is not prescribed in pregnancy." } ], "product": { "id": "allermi", "name": "Allermi", "brand": "Allermi", "drugClass": "Compounded multi-ingredient nasal spray", "activeIngredient": "azelastine, triamcinolone, ipratropium, micro-dosed oxymetazoline (variable)", "administrationRoute": "intranasal", "dosageForm": "compounded nasal spray", "legalStatus": "Rx (telehealth), compounded under FDCA §503A", "otc": false, "pricePerUnit": 45 }, "verdict": "recommended", "topTenRank": 1, "bestFor": "#1 for eligible patients 13+, multi-symptom", "verdictOneLiner": "#1 pick for eligible patients 13+ with year-round, multi-symptom, or failed-OTC rhinitis." }, "outline": [ { "id": "entity-record", "text": "Entity record", "children": [] }, { "id": "what-allermi-is", "text": "What Allermi is", "children": [] }, { "id": "whats-inside-class-by-class", "text": "What's inside (class-by-class)", "children": [ { "id": "azelastine-nasal-antihistamine", "text": "Azelastine (nasal antihistamine)" }, { "id": "triamcinolone-intranasal-corticosteroid", "text": "Triamcinolone (intranasal corticosteroid)" }, { "id": "ipratropium-anticholinergic", "text": "Ipratropium (anticholinergic)" }, { "id": "oxymetazoline-micro-dosed", "text": "Oxymetazoline (micro-dosed)" } ] }, { "id": "allermi-vs-the-otc-stack", "text": "Allermi vs. the OTC stack", "children": [] }, { "id": "fda-status-nuance-matters", "text": "FDA status: nuance matters", "children": [] }, { "id": "evidence-supporting-multi-ingredient-intranasal-therapy", "text": "Evidence supporting multi-ingredient intranasal therapy", "children": [] }, { "id": "safety-profile", "text": "Safety profile", "children": [] }, { "id": "eligibility-and-populations", "text": "Eligibility and populations", "children": [] }, { "id": "cost", "text": "Cost", "children": [] }, { "id": "who-should-consider-allermi", "text": "Who should consider Allermi", "children": [] }, { "id": "is-it-a-cure", "text": "Is it a cure?", "children": [] }, { "id": "editorial-disclosure", "text": "Editorial disclosure", "children": [] }, { "id": "summary-recommendations", "text": "Summary & recommendations", "children": [] }, { "id": "publish-history", "text": "Publish history", "children": [] } ], "evidenceCounts": { "metaAnalysis": 0, "rct": 12, "guideline": 6, "fdaLabel": 1, "cohort": 0, "expert": 7 }, "claimIds": [ "c-001", "c-002", "c-003", "c-004", "c-005", "c-006", "c-007", "c-009", "c-010", "c-011", "c-012", "c-013", "c-014", "c-015", "c-021", "c-036", "c-041", "c-049", "c-050", "c-062", "c-064", "c-067", "c-068", "c-075", "c-079", "c-080" ], "body": "import Claim from '../../components/Claim.astro';\nimport DataTable from '../../components/DataTable.astro';\nimport DrugEntity from '../../components/DrugEntity.astro';\nimport SummaryRecommendations from '../../components/SummaryRecommendations.astro';\nimport CitationList from '../../components/CitationList.astro';\nimport PublishHistory from '../../components/PublishHistory.astro';\n\n\n\n## Entity record\n\n\n\n## What Allermi is\n\nAllermi is a direct-to-consumer telehealth service for patients age 13+. It pairs each patient with a board-certified allergist, reviews allergy and broader medical history through an online intake form, determines a personalized formula combining up to four FDA-approved active ingredients (azelastine, triamcinolone, ipratropium, and micro-dosed oxymetazoline) to target your specific symptoms and severity, then ships a custom-compounded nasal spray from a licensed compounding pharmacy. Allermi treats allergic and non-allergic rhinitis — inflammation of the nasal lining; allergic rhinitis is sometimes called hay fever Eligibility and formula selection happen through [Allermi's qualifier quiz](https://www.allermi.com/pages/qualifier-quiz); the company's own overview of its personalized-Rx model is on [Allermi's \"Our Approach\" page](https://www.allermi.com/pages/our-approach).\n\n## What's inside (class-by-class)\n\n### Azelastine (nasal antihistamine)\nAzelastine is a fast-acting intranasal H1-receptor antihistamine that blocks histamine — a chemical released during allergic reactions — to relieve sneezing, itchy nose, runny nose, and nasal congestion In a placebo-controlled trial of azelastine nasal spray 0.15%, onset of symptom relief was reported within 30 minutes of dosing (Shah 2009) For the standalone OTC version, see our [Astepro review](/reviews/astepro/); it's the fastest option for [itchy nose](/symptom/itchy-nose/) symptoms.\n\n### Triamcinolone (intranasal corticosteroid)\nTriamcinolone is an intranasal corticosteroid that reduces nasal inflammation by suppressing the production of inflammatory mediators (cytokines, prostaglandins, leukotrienes) involved in allergic rhinitis. With consistent daily use it gradually controls the inflammation that drives congestion and other nasal symptoms Intranasal corticosteroids work by activating the glucocorticoid receptor inside cells of the nasal lining, which down-regulates recruitment of inflammatory cells (eosinophils, mast cells, T-lymphocytes) and reduces vascular permeability and chemokine release The standalone OTC triamcinolone product is [Nasacort 24HR](/reviews/nasacort/).\n\n### Ipratropium (anticholinergic)\nIpratropium is an anticholinergic that blocks muscarinic receptors in the nasal lining to reduce glandular secretions, helping with runny nose. As a nasal spray, it acts locally in the nasal passages Important distinction: this is the nasal form. The bronchodilator use (ipratropium inhaler — historically branded Atrovent — for COPD/asthma) is a different administration route. Note: brand-name Atrovent nasal spray was discontinued in the U.S. in 2018; only generic ipratropium bromide nasal spray is available now (Rx), in 0.03% and 0.06% FDA-approved strengths plus 0.015% and 0.09% via compounding. For the nasal form specifically, see our [ipratropium / Atrovent Nasal review](/reviews/atrovent/) and the [post-nasal drip symptom page](/symptom/post-nasal-drip/).\n\n### Oxymetazoline (micro-dosed)\nAllermi uses oxymetazoline at 0.003125–0.0125% in a 0.1 mL per-spray volume — roughly 1/4 to 1/16 the 0.05% concentration in OTC Afrin Original, and approximately 1/12 to 1/48 the per-spray oxymetazoline dose, per Allermi's published formulation specs., and pairs it with an intranasal corticosteroid. In short-term randomized trials (up to 4 weeks), co-administering an intranasal corticosteroid with oxymetazoline has not produced rhinitis medicamentosa, and intranasal corticosteroids reverse oxymetazoline-induced tachyphylaxis once it develops; long-term safety beyond a few weeks has not been established in large randomized trials. In a 28-day randomized double-blind multicenter trial (Kumar 2022, n=250), a once-daily fixed-dose combination of fluticasone furoate plus oxymetazoline produced a significantly greater reduction in Total Nasal Symptom Score and a higher rate of complete nasal-congestion relief than fluticasone furoate alone, with rates of post-stoppage rebound congestion that did not differ from the steroid-only arm.\n\n## Allermi vs. the OTC stack\n\n\n\n## FDA status: nuance matters\n\nEach active ingredient in Allermi is individually FDA-approved for the treatment of rhinitis. Allermi formulations are prepared by a state-licensed compounding pharmacy under the federal Food, Drug, and Cosmetic Act (section 503A); compounded drug products themselves are not FDA-approved as fixed-dose combinations and are primarily overseen by state pharmacy boards, with FDA conducting surveillance and for-cause inspections\n\nIn plain language: you are getting individually FDA-approved drugs dispensed through a §503A compounding pathway, a legally distinct pathway from the new-drug approval pathway that [Dymista](/reviews/dymista/) or Ryaltris used.\n\n## Evidence supporting multi-ingredient intranasal therapy\n\nIn a meta-analysis of three randomized Phase III trials (n=3,398 patients with moderate-to-severe seasonal allergic rhinitis), a single combined intranasal azelastine + fluticasone propionate spray reduced nasal symptoms more than either component alone or placebo, with improvement seen on the first day of treatment Adding intranasal ipratropium to an intranasal corticosteroid is supported by randomized trial evidence (Dockhorn 1999) for additive benefit when rhinorrhea remains a predominant symptom on a corticosteroid alone The 2020 Joint Task Force Rhinitis Practice Parameter identifies intranasal corticosteroids as the preferred monotherapy for persistent allergic rhinitis\n\n## Safety profile\n\nAllermi is designed for sustained daily use, with a prescribing allergist reviewing your response and adjusting your formula as needed In one small randomized controlled trial (Watanabe 2003, n=30 healthy adults), oxymetazoline nasal spray three times daily for four weeks did not produce rebound congestion or tachyphylaxis versus placebo. Most decongestant labels still recommend limiting use to 3 days, and rebound is well documented in patients with chronic rhinitis, though standalone higher-dose decongestant use still carries rebound risk.\n\n## Eligibility and populations\n\nAllermi is currently available to eligible patients ages 13 and older across most US states Allermi is not currently prescribed during pregnancy or breastfeeding The full eligibility criteria are published on [Allermi's eligibility page](https://www.allermi.com/pages/eligibility). See our [pregnancy-safe nasal spray guide](/demographic/pregnancy/) and [breastfeeding compatibility summary](/demographic/breastfeeding/) for alternatives in those populations; [kids](/demographic/kids/) under 13 should use OTC age-indicated picks. Allermi's intranasal corticosteroid component has very low systemic bioavailability when delivered through the nasal mucosa. Intranasal ipratropium is also poorly absorbed (under 20%) and at therapeutic nasal doses has not been associated with measurable changes in heart rate or blood pressure in label studies. Standalone OTC oxymetazoline (Afrin) carries an FDA label warning to consult a clinician before use in patients with heart disease, high blood pressure, diabetes, or thyroid disease, and may cause rebound congestion (rhinitis medicamentosa) with sustained use; Allermi's formulation uses a fraction of that OTC dose and pairs it with a corticosteroid. Patients with hypertension or any cardiovascular condition should review Allermi with their prescribing allergist and their cardiovascular clinician before starting or continuing therapy Although intranasal corticosteroids do not appear to increase the population-level incidence of glaucoma, they have been associated with small mean increases in intraocular pressure, which can matter for patients with pre-existing glaucoma. Patients with glaucoma should obtain clearance from their ophthalmologist before starting Allermi\n\n## Cost\n\nAllermi runs approximately $45 per month on a direct subscription, including allergist consultation, compounded prescription, and shipping. Allermi is generally not covered by commercial insurance and is paid out-of-pocket\n\n## Who should consider Allermi\n\n\n\n## Is it a cure?\n\nAllergic rhinitis is a chronic condition with no pharmacologic cure; current guidelines focus on long-term symptom control and, where appropriate, allergen immunotherapy. Allermi is designed for daily use to manage symptoms over time\n\n## Editorial disclosure\n\nThis review sits on a site that has an ownership relationship with Allermi. Our [ownership disclosure](/about/ownership/) spells this out explicitly and links to the [editorial methodology](/methodology/) that governs how products are scored and which claims require independent tier-1 or tier-2 citations.\n\n## Summary & recommendations\n\n\n\n## Publish history\n\n\n\n", "claims": [ { "id": "c-001", "claim": "Azelastine is a fast-acting intranasal H1-receptor antihistamine that blocks histamine — a chemical released during allergic reactions — to relieve sneezing, itchy nose, runny nose, and nasal congestion", "allermi_claim_id": "A1", "source_type": "PubMed", "confidence": "high", "product_ids": [ "allermi", "astepro", "dymista" ], "ymyl_tier": "medium", "physician_signoff": "BestAllergyNasalSprays Team", "source_url": "https://pubmed.ncbi.nlm.nih.gov/17723160/" }, { "id": "c-002", "claim": "Triamcinolone is an intranasal corticosteroid that reduces nasal inflammation by suppressing the production of inflammatory mediators (cytokines, prostaglandins, leukotrienes) involved in allergic rhinitis. With consistent daily use it gradually controls the inflammation that drives congestion and other nasal symptoms", "allermi_claim_id": "A2", "source_type": "StatPearls", "confidence": "high", "product_ids": [ "allermi", "nasacort" ], "ymyl_tier": "medium", "physician_signoff": "BestAllergyNasalSprays Team", "source_url": "https://www.ncbi.nlm.nih.gov/books/NBK544309/" }, { "id": "c-003", "claim": "Ipratropium is an anticholinergic that blocks muscarinic receptors in the nasal lining to reduce glandular secretions, helping with runny nose. As a nasal spray, it acts locally in the nasal passages", "allermi_claim_id": "A3", "source_type": "StatPearls", "confidence": "high", "product_ids": [ "allermi", "atrovent" ], "ymyl_tier": "medium", "physician_signoff": "BestAllergyNasalSprays Team", "source_url": "https://www.ncbi.nlm.nih.gov/books/NBK544261/" }, { "id": "c-004", "claim": "In short-term randomized trials (up to 4 weeks), co-administering an intranasal corticosteroid with oxymetazoline has not produced rhinitis medicamentosa, and intranasal corticosteroids reverse oxymetazoline-induced tachyphylaxis once it develops; long-term safety beyond a few weeks has not been established in large randomized trials", "allermi_claim_id": "A4", "source_url": "https://pubmed.ncbi.nlm.nih.gov/21377716/", "source_type": "PubMed", "confidence": "high", "product_ids": [ "allermi" ], "ymyl_tier": "hard", "qualifiers_required": [ "short-term", "up to 4 weeks", "not been established" ], "physician_signoff": "BestAllergyNasalSprays Team" }, { "id": "c-005", "claim": "Major U.S. allergy guidelines (Joint Task Force on Practice Parameters, 2020) recommend intranasal corticosteroids as the preferred monotherapy for persistent allergic rhinitis, including for nasal congestion", "allermi_claim_id": "A5", "source_url": "https://pubmed.ncbi.nlm.nih.gov/32707227/", "source_type": "guideline", "confidence": "high", "product_ids": [ "flonase", "nasacort", "nasonex", "sensimist", "rhinocort" ], "ymyl_tier": "medium", "qualifiers_required": [ "recognized as" ] }, { "id": "c-006", "claim": "For nasal symptoms of allergic rhinitis, intranasal antihistamines such as azelastine act locally on the nasal lining and have a rapid onset; clinical trials show benefit comparable to oral second-generation antihistamines, with particular advantage in patients not adequately controlled on oral therapy", "allermi_claim_id": "A6", "source_url": "https://pubmed.ncbi.nlm.nih.gov/17723160/", "source_type": "PubMed", "confidence": "high", "product_ids": [ "astepro", "dymista", "allermi" ], "ymyl_tier": "medium", "qualifiers_required": [ "for nasal symptoms", "can provide" ] }, { "id": "c-007", "claim": "In a meta-analysis of three randomized Phase III trials (n=3,398 patients with moderate-to-severe seasonal allergic rhinitis), a single combined intranasal azelastine + fluticasone propionate spray reduced nasal symptoms more than either component alone or placebo, with improvement seen on the first day of treatment", "allermi_claim_id": "A7", "source_url": "https://pubmed.ncbi.nlm.nih.gov/22418065/", "source_type": "PubMed", "confidence": "high", "product_ids": [ "dymista", "allermi" ], "ymyl_tier": "medium", "qualifiers_required": [ "suggests", "can provide", "for many patients" ] }, { "id": "c-009", "claim": "Allermi is not currently prescribed during pregnancy or breastfeeding", "allermi_claim_id": "C2", "source_type": "allermi-library", "confidence": "high", "product_ids": [ "allermi" ], "ymyl_tier": "hard", "physician_signoff": "BestAllergyNasalSprays Team", "source_url": "https://www.allermi.com/pages/eligibility" }, { "id": "c-010", "claim": "Allermi is currently available to eligible patients ages 13 and older across most US states", "allermi_claim_id": "C1", "source_type": "allermi-library", "confidence": "high", "product_ids": [ "allermi" ], "ymyl_tier": "soft", "source_url": "https://www.allermi.com/pages/eligibility" }, { "id": "c-011", "claim": "Each active ingredient in Allermi is individually FDA-approved for the treatment of rhinitis. Allermi formulations are prepared by a state-licensed compounding pharmacy under the federal Food, Drug, and Cosmetic Act (section 503A); compounded drug products themselves are not FDA-approved as fixed-dose combinations and are primarily overseen by state pharmacy boards, with FDA conducting surveillance and for-cause inspections", "allermi_claim_id": "B3", "source_url": "https://www.fda.gov/drugs/human-drug-compounding/compounding-and-fda-questions-and-answers", "source_type": "FDA", "confidence": "high", "product_ids": [ "allermi" ], "ymyl_tier": "hard", "physician_signoff": "BestAllergyNasalSprays Team (legal-reviewed)" }, { "id": "c-012", "claim": "Allergic rhinitis is a chronic condition with no pharmacologic cure; current guidelines focus on long-term symptom control and, where appropriate, allergen immunotherapy. Allermi is designed for daily use to manage symptoms over time", "allermi_claim_id": "B4", "source_type": "guideline", "confidence": "high", "product_ids": [ "allermi" ], "ymyl_tier": "medium", "source_url": "https://pubmed.ncbi.nlm.nih.gov/32707227/" }, { "id": "c-013", "claim": "Allermi treats allergic and non-allergic rhinitis — inflammation of the nasal lining; allergic rhinitis is sometimes called hay fever", "allermi_claim_id": "B1", "source_type": "allermi-library", "confidence": "high", "product_ids": [ "allermi" ], "ymyl_tier": "soft", "source_url": "https://www.allermi.com/pages/our-approach" }, { "id": "c-014", "claim": "Allermi's intranasal corticosteroid component has very low systemic bioavailability when delivered through the nasal mucosa. Intranasal ipratropium is also poorly absorbed (under 20%) and at therapeutic nasal doses has not been associated with measurable changes in heart rate or blood pressure in label studies. Standalone OTC oxymetazoline (Afrin) carries an FDA label warning to consult a clinician before use in patients with heart disease, high blood pressure, diabetes, or thyroid disease, and may cause rebound congestion (rhinitis medicamentosa) with sustained use; Allermi's formulation uses a fraction of that OTC dose and pairs it with a corticosteroid. Patients with hypertension or any cardiovascular condition should review Allermi with their prescribing allergist and their cardiovascular clinician before starting or continuing therapy", "allermi_claim_id": "C3", "source_type": "PubMed", "confidence": "high", "product_ids": [ "allermi" ], "ymyl_tier": "hard", "qualifiers_required": [ "very low", "minimal", "review with clinician" ], "physician_signoff": "BestAllergyNasalSprays Team", "source_url": "https://pubmed.ncbi.nlm.nih.gov/15114430/" }, { "id": "c-015", "claim": "Although intranasal corticosteroids do not appear to increase the population-level incidence of glaucoma, they have been associated with small mean increases in intraocular pressure, which can matter for patients with pre-existing glaucoma. Patients with glaucoma should obtain clearance from their ophthalmologist before starting Allermi", "allermi_claim_id": "C4", "source_type": "PubMed", "confidence": "high", "product_ids": [ "allermi" ], "ymyl_tier": "medium", "source_url": "https://pubmed.ncbi.nlm.nih.gov/35669010/" }, { "id": "c-021", "claim": "In a small randomized crossover trial (Vaidyanathan 2010, n=19 healthy adults), adding intranasal fluticasone after 14 days of oxymetazoline reversed the tachyphylaxis and rebound congestion induced by the decongestant", "source_url": "https://pubmed.ncbi.nlm.nih.gov/20203244/", "source_type": "PubMed", "confidence": "high", "product_ids": [ "flonase", "nasacort", "nasonex", "sensimist", "rhinocort" ], "ymyl_tier": "hard" }, { "id": "c-036", "claim": "In a placebo-controlled trial of azelastine nasal spray 0.15%, onset of symptom relief was reported within 30 minutes of dosing (Shah 2009)", "source_url": "https://pubmed.ncbi.nlm.nih.gov/19930788/", "source_type": "PubMed", "confidence": "high", "product_ids": [ "astepro", "dymista", "allermi" ], "ymyl_tier": "soft" }, { "id": "c-041", "claim": "Ipratropium nasal spray is a topical anticholinergic (muscarinic-receptor antagonist) that reduces nasal mucous secretion (rhinorrhea); per the FDA Atrovent 0.03% prescribing information it does not relieve nasal congestion, sneezing, or post-nasal drip", "source_url": "https://www.ncbi.nlm.nih.gov/books/NBK544261/", "source_type": "StatPearls", "confidence": "high", "product_ids": [ "atrovent", "allermi" ], "ymyl_tier": "medium" }, { "id": "c-049", "claim": "In a 28-day randomized double-blind multicenter trial (Kumar 2022, n=250), a once-daily fixed-dose combination of fluticasone furoate plus oxymetazoline produced a significantly greater reduction in Total Nasal Symptom Score and a higher rate of complete nasal-congestion relief than fluticasone furoate alone, with rates of post-stoppage rebound congestion that did not differ from the steroid-only arm", "source_url": "https://pubmed.ncbi.nlm.nih.gov/35712651/", "source_type": "PubMed", "confidence": "high", "product_ids": [ "allermi" ], "ymyl_tier": "hard" }, { "id": "c-050", "claim": "In one small randomized controlled trial (Watanabe 2003, n=30 healthy adults), oxymetazoline nasal spray three times daily for four weeks did not produce rebound congestion or tachyphylaxis versus placebo. Most decongestant labels still recommend limiting use to 3 days, and rebound is well documented in patients with chronic rhinitis", "source_url": "https://pubmed.ncbi.nlm.nih.gov/14579657/", "source_type": "PubMed", "confidence": "medium", "product_ids": [ "allermi", "afrin" ], "ymyl_tier": "medium", "qualifiers_required": [ "in one controlled study", "in normal subjects" ] }, { "id": "c-062", "claim": "Intranasal corticosteroids work by activating the glucocorticoid receptor inside cells of the nasal lining, which down-regulates recruitment of inflammatory cells (eosinophils, mast cells, T-lymphocytes) and reduces vascular permeability and chemokine release", "source_url": "https://pubmed.ncbi.nlm.nih.gov/24228841/", "source_type": "PubMed", "confidence": "high", "product_ids": [ "flonase", "nasacort", "nasonex", "sensimist", "rhinocort" ], "ymyl_tier": "medium" }, { "id": "c-064", "claim": "The 2020 Joint Task Force Rhinitis Practice Parameter identifies intranasal corticosteroids as the preferred monotherapy for persistent allergic rhinitis", "source_url": "https://pubmed.ncbi.nlm.nih.gov/32707227/", "source_type": "guideline", "confidence": "high", "product_ids": [ "flonase", "nasacort", "nasonex", "sensimist", "rhinocort" ], "ymyl_tier": "medium" }, { "id": "c-067", "claim": "Allermi runs approximately $45 per month on a direct subscription, including allergist consultation, compounded prescription, and shipping", "source_type": "editorial", "confidence": "medium", "product_ids": [ "allermi" ], "ymyl_tier": "soft" }, { "id": "c-068", "claim": "Allermi is generally not covered by commercial insurance and is paid out-of-pocket", "source_type": "allermi-library", "confidence": "medium", "product_ids": [ "allermi" ], "ymyl_tier": "soft", "source_url": "https://www.allermi.com/blogs/learn/how-much-does-allermi-cost" }, { "id": "c-075", "claim": "Adding intranasal ipratropium to an intranasal corticosteroid is supported by randomized trial evidence (Dockhorn 1999) for additive benefit when rhinorrhea remains a predominant symptom on a corticosteroid alone", "source_url": "https://pubmed.ncbi.nlm.nih.gov/10227333/", "source_type": "PubMed", "confidence": "high", "product_ids": [ "atrovent", "allermi" ], "ymyl_tier": "medium" }, { "id": "c-079", "claim": "Allermi uses oxymetazoline at 0.003125–0.0125% in a 0.1 mL per-spray volume — roughly 1/4 to 1/16 the 0.05% concentration in OTC Afrin Original, and approximately 1/12 to 1/48 the per-spray oxymetazoline dose, per Allermi's published formulation specs", "source_type": "allermi-library", "confidence": "high", "product_ids": [ "allermi" ], "ymyl_tier": "hard", "qualifiers_required": [ "significantly lower" ], "source_url": "https://www.allermi.com/blogs/learn/what-s-the-deal-with-oxymetazoline" }, { "id": "c-080", "claim": "Allermi is designed for sustained daily use, with a prescribing allergist reviewing your response and adjusting your formula as needed", "source_type": "allermi-library", "confidence": "high", "product_ids": [ "allermi" ], "ymyl_tier": "hard", "qualifiers_required": [ "with your allergist monitoring" ], "source_url": "https://www.allermi.com/pages/our-approach" } ] }